Diminished Ovarian Reserve Expert Releases Tip Sheet for Timely Infertility Diagnosis for Young Women

Young women may also be affected by a number of infertility problems, such as diminished ovarian reserve and high FSH.

New York, NY (PRWEB) March 07, 2012

Detecting DOR is not difficult, says Dr. Gleicher, Medical Director and Chief Scientist of CHR. He continues: Ovarian reserve can be easily measured by simple blood tests, like follicle-stimulating hormone (FSH) and anti-Mllerian hormone (AMH). High FSH and/or low AMH suggest a diagnosis of DOR but both need to be assessed in an age-specific way.

However, many fertility centers, unused to treating younger women with premature ovarian aging (POA; a term coined by CHR to describe younger women with DOR), often overlook this condition. They overlook the diagnosis, explains Dr. Gleicher, because they do not utilize age-specific cut off values for FSH and AMH.

Normal FSH ranges increase and normal AMH ranges decrease as women age. If all women of all ages are assessed with universal cutoff values, younger women will never be diagnosed in a timely fashion. Unfortunately, says Dr. Gleicher, this is what is still done in many fertility centers.

Once diagnosed with POA, like older women, women with POA have little time to lose since there is no telling how quickly their POA will progress. Though very rapid progression is rare, according to Dr. Gleicher, CHR physicians have seen women go into full menopause in a few short months after diagnosis.

Dr. Gleicher continues: There isnt a day when we dont hear our patients say doctor, I wish Id known about your center months ago, when I was doing such and such... The earlier we can start treatment, the better, of course, our chances of helping our patients with POA!

CHRs tips for younger women with POA to receive timely diagnosis and treatment include the following:

About Center for Human Reproduction

Center for Human Reproduction, or CHR (http://www.centerforhumanreprod.com), is a leading fertility center in the United States with a worldwide reputation as a "fertility center of last resort," specializing in treatment of infertility in women with diminished ovarian reserve, including younger women with premature ovarian aging (POA) and older women with physiological ovarian aging. Dr. Gleicher is available for additional comments.

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Diminished Ovarian Reserve Expert Releases Tip Sheet for Timely Infertility Diagnosis for Young Women

Premature Ovarian Aging Expert Issues Fertility Tip Sheet for Women Interested in Pregnancy Over 40

New Yorks Center for Human Reproduction releases special advice for women over 40 interested in becoming pregnant.

New York, NY (PRWEB) March 01, 2012

Its important to recognize the urgency of aggressive fertility treatment when you are above age 40, says Dr. Gleicher, Medical Director of CHR, which released the tip sheet. As women get older, their ovarian reserve (a measure of ovaries ability to produce good-quality eggs) declines. Because this process of ovarian aging speeds up significantly after age 40, timely diagnosis of infertility becomes crucial especially after age 40. Every fertility treatment loses efficacy rapidly with declining ovarian reserve.

As a fertility center of last resort for patients with diminished ovarian reserve, CHR sees a large number of women over 40 with premature ovarian aging. Dr. Gleicher continues: There isnt a day when we dont hear our patients say doctor, I wish Id known about your center years ago, when I was doing such and such... The earlier we can start treatment, the better, of course, our chances of helping our patients! This is why we are issuing this fertility tip sheet.

CHRs fertility tips for women trying to get pregnant after 40 include:

About Center for Human Reproduction

Center for Human Reproduction, or CHR (http://www.centerforhumanreprod.com), is a leading fertility center in the United States with a worldwide reputation as a "fertility center of last resort," specializing in treatment of infertility in women with diminished ovarian reserve, including younger women with premature ovarian aging (POA) and older women with physiological ovarian aging. Dr. Gleicher is available for additional comments.

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Communications Manager Center for Human Reproduction (212) 994-4400 4491 Email Information

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Premature Ovarian Aging Expert Issues Fertility Tip Sheet for Women Interested in Pregnancy Over 40

Will GOP View on Women Matter?

Maybe the 2012 election season should be renamed "Biology 2012: Reintroduction to Basic Human Reproduction," with mandatory, nationwide enrollment. As we scuffle our way into Super Tuesday, with 419 Republican delegates at stake, it seems the political focus is on women, and not in the typically scandal-ridden way. The question is how it will affect GOP voters, particularly women.

Though Rush Limbaugh kind of apologized for calling Sandra Fluke a "slut," unclear is whether he included in his apology his very revealing and misinformed request that if the public was going to pay for her contraception, she should be required to post video of herself having sex online. Regardless, sponsor AOL joined seven other former sponsors in pulling advertising. As none of the candidates has condemned Limbaugh's spewage, will female Republicans still show up for them? More important, will they show up for them in November?

Of course the hullabaloo over access to contraception amid the seeming lack of understanding of how it works is not the only attack on women being waged by the right. A Wisconsin legislator has introduced a bill that would include "nonmarital parenthood" as a contributing factor to child abuse and neglect.

Start cutting out your scarlet letters, we'll need plenty. While the wording of the statute reads gender-neutralish, the aim is clear from the last line of the proposed language mandating: "Educational and public awareness materials and programming that emphasize nonmarital parenthood as a contributing factor to child abuse and neglect and the role of fathers in the primary prevention of child abuse and neglect."

So if the children resulting from "nonmartial parenthood" live with their fathers, is nonmartial parenthood no longer abusive? Even if the mother is not in the picture? What do you say about this one, GOP candidates? What's that I hear? Sounds a lot like crickets.

Back to our Biology 2012 course materials. If we decrease access to contraception, rates of "nonmarital parenthood" will increase. It's simple. And the GOP policy has laid the blame squarely on the doorstep of women, making conception a one-woman show.

There has been no name calling of the presumed sexual partners of the Georgetown women Limbaugh lambasted; they have not been mentioned in the discussion. So all these "immoral" women are having all this imagined sex seemingly considered in relishing detail, for which they shouldn't have contraception, and then therefore are having these "nonmarital" children with whom?

I suppose boys will be boys. If that wasn't the case, perhaps one of you might have raised this issue. Their silence only further demonstrates the need for Biology 2012, Lesson 1: It Takes Two to Form a Zygote.

The policies and viewpoints being espoused by Republicans are calculatedly, derogatorily and vehemently punitive of women for the mere basis of biology. Will Republican women care? Perhaps we'll find out Tuesday.

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Will GOP View on Women Matter?

New Stem Cell Research Could End the Hard Stop of Female Fertility

A long-held belief about women and fertility is that each woman has a set amount of eggs in her lifetime and that when those eggs are depleted at menopause, so are her chances at having a biological child. However, research out of Massachusetts General Hospital questioning that view. Using stem cells taken from human ovaries, scientists have produced early-stage eggs, which brings up all sorts of questions about possible new methods for treating infertility. Nicholas Wade, writing in the New York Times, adds, "The ability to isolate stem cells from which eggs could be cultivated would help not only with fertility but also with biologists’ understanding of how drugs and nutrition affect the egg cells."

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Jonathan Tilly, the director of Mass General's Vincent Center for Reproductive Biology and leader of the new research, had reported in 2004 that ovarian stem cells in mice could create new eggs "similar to how stem cells in male testes produce sperm throughout a man’s life." His new study attempted to prove this with humans. Researchers took healthy ovaries from patients having sex reassignment surgery, and injected stem cells from the ovaries into human ovarian tissue grafted under the skin of mice: "Within two weeks, early stage human follicles with oocytes had formed." Ryan Flinn writes in Bloomberg Businessweek that this could potentially point at "new ways to aid fertility by delaying when the ovaries stop functioning." 

RELATED: The Super Discriminating Powers of Ovulating Women

Dr. Tilly has long been a proponent of the belief that women might be able to produce new eggs, and has said the 50-year belief otherwise is based on lack of evidence rather than on data proving that it's impossible. In 2005, he reported that women have a "hidden reserve of cells in the bone marrow that constantly replenish the ovaries with new eggs," though other researchers have not been able to confirm his finding. 

RELATED: Richard Dawkins Gets into a Comments War with Feminists

Along with opening new doors to understanding the incredibly complex human egg cell, this new research could eventually have very practical implications for the 10 percent of child-bearing age women in the U.S. who have fertility problems. More philosophically, it opens up a new way of thinking about the hard-stop in women's lives for having kids. While fertility technologies like in-vitro and egg freezing are happening to some extent, Tilly's team is exploring the way this new knowledge could improve in-vitro -- IVF involves a limited number of eggs -- and also looking into possibility of developing an ovarian stem-cell bank with eggs that could be "cryogenically frozen and thawed without damage, unlike human eggs." 

“The problem we face with IVF is we don’t have many eggs to work with,” said Tilly. “These cells are renewable. If we are successful -- and it’s a big if -- in generating functioning eggs from these cells, we can generate as many eggs as we need to on a per patient basis.”

Researchers warn that there's a ways to go before there are any real applications to this, if ever. Female reproduction expert David Albertini said it's still unclear whether the egg cells yielded actually could be used in human fertility. Cells grown in laboratories are more likely to develop abnormalities; even if they are proven viable, it's a given that there will be numerous social and political aspects that factor in down the road. Nonetheless, evidence that women's eggs may not be the finite commodity we all thought they were seems poised to make a huge impact across many aspects of contemporary life. What would if mean, for instance, if the old ticking "biological clock" no longer applied -- or applied to women and men more equivalently? 

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As Tilly said in a recording released to the press, "If we can guide the process correctly, I think it opens up a chance that sometime in the future, we might get to the point of actually having an unlimited source of human eggs. A woman could come in, have a small biopsy taken from her ovary for us to retrieve these cells. Once we get these cells out, we can take a hundred of them and make a million of them. If we can get to the stage of generating functional human eggs outside the body, it would rewrite essentially human assisted reproduction."

RELATED: Lubrication Can Be Good, Caffeine Can Be Bad

Brave new world? Maternity ages stretching into the 50s and 60s? Or simply another step toward the prediction some have made that sex will be just a recreational activity in another 10 years?

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New Stem Cell Research Could End the Hard Stop of Female Fertility

Stem Cell Finding Could Expand Women's Lifetime Supply of Eggs

SUNDAY, Feb. 26 (HealthDay News) -- Researchers report that they've isolated stem cells from adult human ovaries that can mature into eggs that may be capable of fertilization.

The lab findings, which upend longstanding scientific theory, could potentially lead to new reproductive technologies and possibly extend the years of a woman's fertility.

It was long believed that women were born with a lifetime supply of eggs, which was depleted by menopause. But a growing body of research -- including a new paper from Massachusetts General Hospital -- suggests egg production may continue into adulthood. The study is published in the March issue of Nature Medicine.

"Fifty years of thinking, in every aspect of experiments, of interpreting the results, and of the clinical management of ovarian function and fertility in women was dictated by one simple belief that turns out to be incorrect," said lead study author Jonathan Tilly, director of the hospital's Vincent Center for Reproductive Biology. "That belief was the egg cell pool endowed at birth is a fixed entity that cannot be renewed."

Dr. Avner Hershlag, chief of the Center for Human Reproduction at North Shore-LIJ Health System in Manhasset, N.Y., said the study is "exciting" but emphasized the work is still very preliminary.

"This is experimental," Hershlag said. "This is a beginning of perhaps something that could bring in new opportunities, but it's going to be a long time in my estimation until clinically we'll be able to actually have human eggs created from stem cells that make babies."

The same team at Mass General caused a stir in 2004 when it published a paper in Nature reporting that female mice retain the ability to make new egg cells well into adulthood.

In both mice and humans, the vast majority of egg cells die through a process called programmed cell death, or apoptosis, the body's way of eliminating unneeded or damaged cells. For humans, that process is dramatic. Female fetuses have about 6 to 7 million eggs at about 20 weeks' gestation, a little more than 1 million at birth, and about 300,000 by puberty.

Studying mice egg cells and follicles, the tiny sacs in which stem cells become eggs, the Mass General researchers discovered something that didn't make mathematical sense.

Most prior research had focused on counting the healthy eggs in the ovaries, and then made assumptions about how many had died from that, Tilly said. But his lab looked at it the opposite way and focused on cell death.

"We found far too many eggs were dying than could be accounted for by the net change in the healthy egg pool," Tilly said. "We reasoned that maybe the field had missed something." They wondered if stem, or precursor cells, were repopulating the ovaries with new eggs.

Initially, the findings were met with skepticism, according to the study authors, but subsequent research bolstered the conclusions.

Those included a 2009 study from a team in China, published in Nature Cell Biology, that isolated, purified and cultured egg stem cells from adult mice, and subsequently introduced them into mice ovaries that were rendered infertile. The infertile mice eventually produced mature oocytes that were fertilized and developed into healthy baby mice.

Studies showing that women had the same capacity as mice were lacking, however.

In this study, Tilly's team used tissue from Japanese women in their 20s and 30s with gender identity disorder, who had their ovaries removed as part of gender reassignment surgery.

The researchers isolated the egg precursor cells and inserted into them a gene from a jellyfish that glows green, then inserted the treated cells into biopsied human ovarian tissue. They then transplanted the human tissue into mice. The green fluorescence allowed researchers to see that the stem cells generated new egg cells.

Tilly said the process makes evolutionary sense. "If you look at this from an evolutionary perspective, males have sperm stem cells that continually make sperm. Because species propagation is so important, we want to make sure it's the best sperm, so don't want sperm sitting around for 60 years waiting to get used," he said. It makes no sense from an evolutionary perspective that "females will be born with all the eggs they will have and let them sit there," he noted.

Hershlag, meanwhile, said much remains to be overcome.

"Ultimately, in our field only one thing counts," he said, "and that is if you can make an egg that can make a healthy baby."

More information

The U.S. National Library of Medicine has more on how human embryos develop.

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Stem Cell Finding Could Expand Women's Lifetime Supply of Eggs

Study finds stem cells can create human eggs

Researchers at Massachusetts General Hospital say they have extracted stem cells from human ovaries and made them generate egg cells. The advance, if confirmed, might provide a new source of eggs for treating infertility, though scientists say it is far too early to tell if the work holds such promise.

Women are born with a complement of egg cells that must last throughout life. The ability to isolate stem cells from which eggs could be cultivated would help not only with fertility but also with biologists' understanding of how drugs and nutrition affect the egg cells.

The new research, by a team led by the biologist Jonathan L. Tilly, depends on a special protein found to mark the surface of reproductive cells like eggs and sperm. Using a cell-sorting machine that can separate out the marked cells, the team obtained reproductive cells from mouse ovaries and showed that the cells would generate viable egg cells that could be fertilized and produce embryos.

They then applied the same method to human ovaries donated by women at the Saitama Medical Center in Japan who were undergoing sex reassignment. The team was able to retrieve reproductive cells that produced immature egg cells when grown in the laboratory. The egg cells, when injected into mice, generated follicles, the ovarian structure in which eggs are formed, as well as mature eggs.

The results were published online Sunday by the journal Nature Medicine.

Tilly and

colleagues wrote that their work opens up "a new field in human reproductive biology that was inconceivable less than 10 years ago."

David Albertini, an expert on female reproduction at the Kansas University Medical Center, called the report "a real technological tour de force," but added that it was not yet clear whether the procedure yielded real egg cells that could be used in human fertility.

"None of the criteria that we in the field use to establish that a cell is a high-quality oocyte are satisfied here," he said, using the scientific term for an unfertilized egg.

Even if the research is validated, the immediate use of the cells in question would be to generate egg cells for research use, like testing the effects of drugs. Use in fertility treatments would be far off, Albertini said, because cells grown in the laboratory often develop abnormalities, a problem that would need correction before any egg could be accepted for fertilization.

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Study finds stem cells can create human eggs

Future Fertility Fix? Egg-Producing Stem Cells Found in Human Ovaries

Study Suggests Women May Be Able to Make More Eggs as They Age

Feb. 26, 2012 -- Scientists say they have found a way to use ovarian stem cells to perhaps one day help infertile women get pregnant -- or add years to a woman’s reproductive cycle.

In a study published in Nature Medicine, researchers report finding egg-producing stem cells in human ovaries. They also report being able to make some of those ovarian stem cells grow into immature eggs that may someday be useful for reproduction.

At this point, such “seed” eggs can’t be fertilized by sperm. But if scientists are able to entice them to mature and can prove they can be fertilized and grow into embryos -- a feat that has been reported in mice -- it would overturn a long-held scientific belief that women can’t make new eggs as they get older.

“What it does is really open a door into human reproduction that 10 years ago didn’t even exist,” says researcher Jonathan L. Tilly, PhD, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital, in Boston.

Outside experts agree. They say the findings could have profound importance for reproductive medicine and aging, allowing doctors not only to restore a woman’s fertility but also to potentially delay menopause.

“I think the significance of this work is like reporting that we found microorganisms on Mars,” says Kutluk Oktay, MD, who directs the Division of Reproductive Medicine and the Institute for Fertility Preservation at New York Medical College in Valhalla, N.Y.

Still, It’s a Long Way to Mars

“It’s a proof of principle that they could do it,” says David F. Albertini, PhD, director of the Center for Reproductive Sciences at the University of Kansas Medical Center in Kansas City, Kan.

“The world wants to know today if we’re ready to restore fertility in women, whether they’ve aged or been treated for cancer or whatever,” Albertini says, adding that he doesn’t think that’s on the horizon. “This is an extremely rare event, at best.”

The egg-generating stem cells the researchers were able to extract from ovaries were very rare. The researchers only came across one for every 10,000 or so ovarian cells that they counted.

But when they took those cells and implanted them back into human ovarian tissue, they divided and essentially made young eggs.

Tilly says his team stopped short of trying to make one of the eggs functional because “for a lot of reasons, as it should be,” it is illegal in the U.S. to experimentally fertilize human eggs.

“We think the evidence provided clearly indicates that this very unique, newly discovered pool of cells does exist in women,” he says.

A Lot of Potential

“It’s a really exciting result,” says Evelyn Telfer, PhD, a cell biology expert at the University of Edinburgh in Scotland.

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Future Fertility Fix? Egg-Producing Stem Cells Found in Human Ovaries

Pioneering lab work aims to smash women's fertility barrier

An experiment that produced human eggs from stem cells could one day be a boon for women who are desperate to have a baby, according to a study published on Sunday.

The work sweeps away the belief that a woman has only a limited stock of eggs and replaces it with the theory that the supply is continuously replenished from precursor cells in the ovary, its authors said.

"The prevailing dogma in our field for the better part of the last 50 or 60 years was that young girls at birth were given a bank account of eggs at birth that's not renewable," said Jonathan Tilly, director of the Vincent Center for Reproductive Biology at Massachusetts General Hospital, who led the research.

"As they become mature and become a woman, they use those eggs up (and) the ovaries will fail when they enter menopause."

Tilly first challenged the "bank account" doctrine eight years ago, suggesting female mammals continue producing egg-making cells into adulthood rather than from a stock acquired at birth.

His theory ran into a firestorm.

Other scientists challenged the accuracy of his experiments or dismissed their conclusions as worthless, given that they had only been conducted on lab mice.

But the new work, said Tilly, not only confirms his controversial idea, but takes it farther.

In it, his team isolated egg-producing stem cells in human ovaries and then coaxed them into developing oocytes, as eggs are called.

Building on a feat by Chinese scientists, they pinpointed the oocyte stem cells by using antibodies which latched onto a protein "handle" located on the side of these cells.

The team tagged the stem cells with a fluorescent green protein -- a common trick to help figure out what happens in lab experiments.

The cells were injected into biopsied human ovarian tissue which was then grafted beneath the skin of mice.

Within 14 days, the graft had produced a budding of oocytes. Some of the eggs glowed with the fluorescent tag, proving that they came from the stem cells. But others did not, which suggested they were already present in the tissue before the injection.

Tilly said "the hairs were standing up on my arm" when he saw time-elapse video showing the eggs maturing in a lab dish.

Further work needs to be done to test the viability of the eggs, and little is known about the hormones or other mechanisms by which oocytes emerge from the stem cells.

But the impact could be far-reaching, Tilly said.

"If we can guide the process correctly, I think it opens up a chance that sometime in the future, we might get to the point of actually having an unlimited source of human eggs," Tilly said in a video recording released to the press.

"A woman could come in, have a small biopsy taken from her ovary for us to retrieve these cells. Once we get these cells out, we can take a hundred of them and make a million of them.

"If we can get to the stage of generating functional human eggs outside the body, it would rewrite essentially human assisted reproduction."

According to a press release issued by Massachusetts General Hospital, Tilly's team are already exploring the idea of banks where oocyte stem cells can be frozen and stored, and then retrieved when a woman wants to have a baby.

Human eggs are extremely delicate and likely to suffer damage when frozen and thawed, but this risk does not apply to the egg cells that make them, it said.

Previous work has shown that around one in 10 women of reproductive age is at risk of premature ageing of the ovaries, a finding with repercussions in societies where women opt ever later to become mothers.

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Pioneering lab work aims to smash women's fertility barrier

The use of androgens or androgen-modulating agents in poor responders undergoing in vitro fertilization: a systematic review and meta-analysis

BACKGROUND

The aim of this meta-analysis was to evaluate the role of androgens or androgen-modulating agents on the probability of pregnancy achievement in poor responders undergoing IVF.

METHODS

Medline, EMBASE, CENTRAL, Scopus and Web of Science databases were searched for the identification of randomized controlled trials evaluating the administration of testosterone, dehydroepiandrosterone (DHEA), aromatase inhibitors, recombinant luteinizing hormone (rLH) and recombinant human chorionic gonadotrophin (rhCG) before or during ovarian stimulation of poor responders.

RESULTS

In two trials involving 163 patients, pretreatment with transdermal testosterone was associated with an increase in clinical pregnancy [risk difference (RD): +15%, 95% confidence interval (CI): +3 to +26%] and live birth rates (RD: +11%, 95% CI: +0.3 to +22%) in poor responders undergoing ovarian stimulation for IVF. No significant differences in clinical pregnancy and live birth rates were observed between patients who received DHEA and those who did not. Similarly, (i) the use of aromatase inhibitors, (ii) addition of rLH and (iii) addition of rhCG in poor responders stimulated with rFSH for IVF were not associated with increased clinical pregnancy rates. In the only eligible study that provided data, live birth rate was increased in patients who received rLH when compared with those who did not (RD: +19%, 95% CI:+1 to +36%).

CONCLUSIONS

Based on the limited available evidence, transdermal testosterone pretreatment seems to increase clinical pregnancy and live birth rates in poor responders undergoing ovarian stimulation for IVF. There is insufficient data to support a beneficial role of rLH, hCG, DHEA or letrozole administration in the probability of pregnancy in poor responders undergoing ovarian stimulation for IVF.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

Human ovarian stem cells may hold promise for treating infertility: study

In research that could have far-reaching implications for female fertility, U.S. scientists have isolated stem cells from human ovarian tissue that give rise to what appear to be normal egg cells.

The finding, published Sunday in the journal Nature Medicine, builds on earlier landmark papers by the Boston researchers, which suggest that female mammals continue producing egg cells, known as oocytes, into adulthood.

Since 2004, the scientists at Massachusetts General Hospital have produced a series of papers based on work in laboratory mice, which challenge the long-held belief that female mammals are born with a finite number of eggs that run out at a certain point in the life cycle.

The team was able to isolate stem cells from ovarian tissue taken from mice, from which they grew fully functional egg cells in the lab, which could then be fertilized and even produce healthy offspring.

"The primary objective of the current study was to prove that oocyte-producing stem cells do, in fact, exist in the ovaries of women during reproductive life, which we feel this study demonstrates very clearly," said lead author Jonathan Tilly, director of the Vincent Center for Reproductive Biology at Massachusetts General.

In their experiments, the team isolated the stem cells from ovarian tissue that had been removed from women in their 20s and early 30s.

When put in culture dishes in the lab, these stem cells gave rise to cells with the characteristic features of oocytes, including the physical appearance and gene expression patterns of those seen inside human ovaries.

"They spontaneously generate eggs in the dish," Tilly said in a phone interview, noting that they proliferate so well that a small number of stem cells could easily spawn a million egg cells in the lab.

The researchers next took stem cells they had genetically manipulated to glow green and injected them into snippets of human ovarian tissue. These prepared tissue bits were then grafted beneath the skin of specially bred mice, which have no immune system that can cause rejection of human tissue.

Within two weeks, researchers discovered the implanted ovarian tissue in the mice contained numerous immature human follicles with egg cells that originated from the injected stem cells. Follicles are small sacs within the ovary which contain maturing eggs.

Tilly said they knew the eggs cells had arisen from the injected stem cells "because they were all green."

Among the many potential clinical applications the researchers are exploring is whether these stem cells could produce oocytes that could play a role in in-vitro fertilization, as well as other applications to improve the outcomes of IVF and other infertility treatments.

"Can we use these cells for fertility reasons to maximize the opportunity for patients who are experiencing infertility to have different options available to them to have a genetically matched child?" asked Tilly.

"I think it's a fairly good possibility that at some point in the not-too-distant future there will be clinical protocols developed using some aspect of these cells or their properties that will have a significant impact on human reproduction."

Among them is the idea of extracting structures responsible for energy production in cells — called mitochondria — from the stem cells and injecting them into a woman's eggs at the time of in-vitro fertilization, with the hope of boosting the chances of conception and a successful birth.

But Tilly said another idea is to see whether these ovarian stem cells could be used to delay menopause — and the myriad health effects that can develop as women age.

"I've always been intrigued by the prospects of what if you could slow the rate at which the egg cell pool goes away and end up keeping an ovary functioning long past its normal time of failure," he said.

"With these egg stem cells, it raises the prospect that by harnessing the power of those cells, perhaps we can control the rate at which that precious reserve of egg cells is depleted and maybe even delay it ... And if you could achieve that, what would happen? Would we truly see a benefit or would there be unforeseen bad effects?"

More than a decade ago, Tilly's lab created a mouse through genetic manipulation that did not experience ovarian failure with age and was able to maintain an adequate reservoir of eggs.

"So it didn't undergo the equivalent of menopause," he said, or "mouseopause" as the scientists have dubbed it.

While normal mice as they reach old age experience health problems similar to those of postmenopausal women — including declining eyesight and hearing, hair loss, osteoporosis, diminished cognitive function and reduced muscle mass — these genetically modified mice did not. Nor did they have an increased risk of cancer.

So could these stem cells one day be used as the basis for an anti-aging treatment?

"There would be some pretty significant health benefits that would come out of it," said Tilly, if that were the case.

Even though every aspect of the human oocyte-producing stem cells have so far matched what the researchers have found in their mouse equivalents, Tilly conceded that "mouse is mouse — and perhaps human will be different."

"We don't know" if eggs generated from human ovarian stem cells will be normal and healthy, he said. "We will have to be very careful if and when we get to that stage."

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Human ovarian stem cells may hold promise for treating infertility: study

Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis

BACKGROUND

Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder associated with cardiovascular disease (CVD) risk factors and metabolic disturbances. This systematic review and meta-analysis was conducted to determine whether carotid intima-media thickness (CIMT), a marker of subclinical atherosclerosis, is higher in women with PCOS compared with women without PCOS.

METHODS

Primary articles reporting the mean CIMT in women with PCOS and controls were identified using Ovid MEDLINE, EMBASE and PUBMED. We performed a random-effects meta-analysis and created forest plots of the mean difference in CIMT and conducted tests for heterogeneity and publication bias. Studies were grouped by quality, defined by reporting reproducibility of CIMT and averaging both common carotid arteries versus one side for CIMT.

RESULTS

From the 36 eligible full-text studies, 8 studies were included in the systematic review and 19 studies were included in the meta-analysis (total n= 1123 women with PCOS, n= 923 controls). The summary mean difference in CIMT among women with PCOS compared with controls was 0.072 mm [95% confidence interval (CI) 0.040, 0.105, P < 0.0001] for highest quality studies, 0.084 mm (95% CI 0.042, 0.126, P = 0.0001) for good quality studies, 0.041 (95% CI –0.038, 0.120, P = 0.310) for fair-quality studies and 0.045 (95% CI –0.020, 0.111, P = 0.173) for lower quality studies.

CONCLUSIONS

Larger studies with a well-defined PCOS population using rigorous methodology may be required to draw a more robust conclusion. However, these results suggest women with PCOS are at a greater risk of premature atherosclerosis, which emphasizes the importance of screening and monitoring CVD risk factors in women with PCOS.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

Assisted reproduction treatment and epigenetic inheritance

BACKGROUND

The subject of epigenetic risk of assisted reproduction treatment (ART), initiated by reports on an increase of children with the Beckwith–Wiedemann imprinting disorder, is very topical. Hence, there is a growing literature, including mouse studies.

METHODS

In order to gain information on transgenerational epigenetic inheritance and epigenetic effects induced by ART, literature databases were searched for papers on this topic using relevant keywords.

RESULTS

At the level of genomic imprinting involving CpG methylation, ART-induced epigenetic defects are convincingly observed in mice, especially for placenta, and seem more frequent than in humans. Data generally provide a warning as to the use of ovulation induction and in vitro culture. In human sperm from compromised spermatogenesis, sequence-specific DNA hypomethylation is observed repeatedly. Transmittance of sperm and oocyte DNA methylation defects is possible but, as deduced from the limited data available, largely prevented by selection of gametes for ART and/or non-viability of the resulting embryos. Some evidence indicates that subfertility itself is a risk factor for imprinting diseases. As in mouse, physiological effects from ART are observed in humans.

In the human, indications for a broader target for changes in CpG methylation than imprinted DNA sequences alone have been found. In the mouse, a broader range of CpG sequences has not yet been studied. Also, a multigeneration study of systematic ART on epigenetic parameters is lacking.

CONCLUSIONS

The field of epigenetic inheritance within the lifespan of an individual and between generations (via mitosis and meiosis, respectively) is growing, driven by the expansion of chromatin research. ART can induce epigenetic variation that might be transmitted to the next generation.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

Patient-focused Internet interventions in reproductive medicine: a scoping review

BACKGROUND

The Internet has revolutionized fertility care since it became a popular source of information and support for infertile patients in the last decade. The aim of this scoping review is to map (i) the main categories of patient-focused Internet interventions within fertility care, (ii) the detailed composition of the interventions and (iii) how these interventions were evaluated.

METHODS

A literature search used various ‘Internet’ and ‘Infertility’ search terms to identify relevant studies published up to 1 September 2011. The selected studies had to include patients facing infertility and using an infertility-related Internet intervention. We charted data regarding categories of interventions, components of interventions and evaluation methodology. We categorized the stages of research using the UK's Medical Research Council framework for evaluating complex interventions.

RESULTS

We included 20 studies and identified 3 educational interventions, 2 self-help interventions, 1 human-supported therapeutic intervention, 9 online support groups and 2 counselling services. Information provision, support and mental health promotion were common aims. Few interactive online components were present in the online programmes. Three studies were in the pilot phase and 17 were in the evaluation phase.

CONCLUSIONS

Several categories of patient-focused Internet-based interventions in fertility care are primarily applied to provide support and education and promote mental health. The interventions could be improved by using more interactive and dynamic elements as their key components. Finally, more emphasis on methodological standards for complex interventions is needed to produce more rigorous evaluations. This review shows where further development or research into patient-focused Internet interventions in fertility-care practice may be warranted.

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http://humupd.oxfordjournals.org/rss/current.xml

Genetics of age at menarche: a systematic review

BACKGROUND

Menarche is the first menstrual period of a girl at puberty. The timing of menarche is important for health in later life. Age at menarche is a complex trait and has a strong genetic component. This review summarizes the results of the genetic studies of age at menarche conducted to date, highlights existing problems in this area and outlines prospects of future studies on genetic factors for the trait.

METHODS

PubMed and Google Scholar were searched until May 2011 using the keywords: ‘menarche’, ‘puberty’ and ‘age at menarche’ in combination with the keywords ‘polymorphism’, ‘candidate gene’, ‘genome-wide association study’ and ‘linkage’.

RESULTS

Our search yielded 170 papers, 35 of which were selected for further analysis. Several large-scale genome-wide association studies along with a powerful meta-analysis of their aggregated data identified about 50 candidate genes for the trait. Some genes were replicated in different studies of Caucasians (e.g. LIN28B, TMEM38B) or in different ethnicities (e.g. SPOCK, RANK and RANKL). However, despite the large volume of results obtained, there is a huge gap in relevant data on ethnic groups other than Caucasians.

CONCLUSIONS

The reviewed studies laid a solid basis for future research on genetics of age at menarche. However, as yet specific genes for this trait have not been identified consistently in all ethnicities and types of studies. We suggest expanding the research to different ethnicities and propose several methodologies to increase the efficiency of studies in this area, including a systems approach, which combines existing high-throughput methods in a single pipeline.

Source:
http://humupd.oxfordjournals.org/rss/current.xml

Mitochondrial haplotype does not influence sperm motility in a UK population of men

BACKGROUND

Sperm motility is regulated by mitochondrial enzymes that are partially encoded by mitochondrial DNA (mtDNA). MtDNA has therefore been suggested as a putative genetic marker of male fertility. However, recent studies in different populations have identified both significant and non-significant associations between mtDNA variation and sperm motility. Here, we tested whether mtDNA variation was associated with sperm motility in a large cohort of men from the UK, to test the robustness of previous studies and the reliability of mtDNA as a marker of poor sperm motility.

METHODS

A total of 463 men attending for semen analysis as part of infertility investigations were recruited from a UK laboratory. Sperm motility was measured using both computer-assisted sperm analysis and traditional manual measurements. MtDNA haplogroup and haplotype were determined in 357 and 298 men, respectively, using single nucleotide polymorphism (SNP) markers throughout the mtDNA genome, and compared with sperm motility data. The linkage between the SNP markers, and possible associations between individual SNPs and motility, were also investigated.

RESULTS

We found no statistical association between haplogroup or haplotype and sperm motility, regardless of how it was measured (P > 0.05 in all cases). Moreover, individual SNPs which were in linkage disequilibrium and dispersed across the mitochondrial genome, and therefore sensitive to mtDNA variation, were not predictive of sperm motility.

CONCLUSIONS

Mitochondrial haplotype is unlikely to be a reliable genetic marker of male factor infertility.

Source:
http://humrep.oxfordjournals.org/rss/current.xml

The interests of children conceived through egg and sperm donation must be protected

From Wednesday's Globe and Mail Published Tuesday, Feb. 21, 2012 7:30PM EST Last updated Tuesday, Feb. 21, 2012 11:04PM EST

Children who are conceived with an egg or sperm donor should have the right to know their biological origins. The quest for this knowledge is really a quest to know themselves. In the same way governments once moved toward eliminating the presumption of anonymity from adoption rules, they must now reform laws around egg and sperm donation, and acknowledge the importance of this issue to donor-conceived offspring. Any changes, however, should not be applied retroactively.

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Currently in Canada, the law guiding this complex aspect of assisted human reproduction is unclear. Provincial fertility clinics collect the medical history of egg and sperm donors, but under federal legislation, donors are not required to give up confidentiality.

This leaves donor-conceived offspring in the dark, forced to fight expensive and time-consuming legal battles when they become adults and inevitably start to ask questions about their life narrative. One such battle is under way in British Columbia, where the government is appealing a lower court ruling that found a woman named Olivia Pratton, conceived in 1982 at a Vancouver fertility clinic, had the legal right to know the identity of the sperm donor. The government argued this month in court that it has no constitutional obligation to include donor-conceived offspring in the Adoption Act, and accord them the same rights to know their biological parentage.

Research shows that depriving children of the ability to access their genetic backgrounds can cause them psychological harm. Much less likely, they could inadvertently end up in a romantic relationship with a half-sibling. The experience of hiding the truth from adoptive children has shown how destructive family secrets can be.

Other countries have already moved forward; in Australia, the U.K., and Sweden, all egg and sperm donors must now agree to disclose their identities. There are national registries to ensure that donor-conceived offspring can access the information when they come of age, even if clinics close and records are lost.

In Canada, the regulatory framework is complicated by the fact that the Supreme Court of Canada struck down parts of the Assisted Human Reproductive Act in 2010, ruling it is up to the provinces to regulate fertility clinics. It left in place a ban on paying donors, and other elements in the act, including those governing the use of human embryos in stem-cell research. But there are regulatory voids.

It is time for Ottawa to work with the provinces to bring clarity to this important aspect of assisted reproduction, and ensure that the best interests of all donor-conceived offspring are taken into account.

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The interests of children conceived through egg and sperm donation must be protected

The use of power Doppler colour scoring to predict successful expectant management in women with an incomplete miscarriage

OBJECTIVE

To evaluate whether the use of power Doppler to confirm the presence or absence of blood flow within retained products of conception (RPC) in women with an incomplete miscarriage can predict subsequent successful expectant management.

METHODS

Prospective observational study in the Acute Gynaecology and Early Pregnancy Unit (AGEPU) at Nepean Hospital from November 2006 to February 2009. Incomplete miscarriage was defined by the presence of a measurable focus of hyperechoeic material, in three planes, within the endometrial cavity using two-dimensional greyscale transvaginal ultrasound (TVS). Subjective qualitative power Doppler colour scoring (PDCS) of the RPC was performed. The vascularization of the RPC was scored using the colour scoring system of the International Ovarian Tumour Analysis (IOTA) group. PDCS 1 meant absence of vascularity, PCDS 2 represented minimal vascularity, PDCS 3 rather strong vascularity and PDCS 4 very strong vascularity. The correlation between the PDCS and successful expectant management of miscarriage was analysed. The volume of RPC was calculated using the ellipsoid formula and then compared with both the PDCS and the outcome of expectant management. Successful expectant management was defined as the resolution of symptoms and the absence of RPC on follow-up TVS.

RESULTS

A total of 1395 consecutive pregnant women underwent TVS. Of them, 198 women were diagnosed with an incomplete miscarriage; 172 were managed expectantly. Complete data were available on 158 cases. In total 84.8% (134/158) were managed successfully whilst 15.2% (24/158) failed expectant management. Of the total, 89% (121/136) of women with a PDCS 1 had successful expectant management compared with 57.1 (8/14) with PDCS 2 and 62.5% (5/8) with PDCS 3. Comparing absence of flow (PDCS 1) to presence of flow (PDCS 2 or more), the rate of success was significantly higher in the first group (89 versus 60.9%, Fisher's exact test P= 0.00136). In the prediction of success, the absence of flow showed a sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ratio of 90.3, 37.5, 89, 40.9% and 1.445 (95% confidence interval: 1.055–1.979), respectively. There was no correlation between the volume of RPC and the PDCS; and there was no relationship between the volume of RPC and the success of expectant management.

CONCLUSIONS

PDCS can predict the likelihood of successful expectant management of incomplete miscarriage. The absence of flow on power Doppler is associated with a significant improvement in the rate of successful expectant management. This new approach may be helpful in quantifying the chances of successful expectant management in those women with an incomplete miscarriage at the primary scan.

Source:
http://humrep.oxfordjournals.org/rss/current.xml

Alkaline and neutral Comet assay profiles of sperm DNA damage in clinical groups

BACKGROUND

The analysis of sperm DNA fragmentation has become a new marker to predict male infertility, and many techniques have been developed. The sperm Comet assay offers the possibility of differentiating single- and double-stranded DNA (ssDNA and dsDNA) breaks, which could have different effects on fertility. The objective of this study was to perform a descriptive characterization of different groups of patients, such as those with asthenoteratozoospermic (ATZ) with or without varicocele, oligoasthenoteratozoospermic (OATZ) or balanced chromosome rearrangements, as compared with fertile donors. The Comet assay was used to investigate sperm samples for ssDNA and dsDNA breaks.

METHODS AND RESULTS

The analysis of alkaline and neutral Comet assays in different groups of patients showed different sperm DNA damage profiles. Most fertile donors presented low values for ssDNA and dsDNA fragmentation (low-equivalent Comet profile), which would be the best prognosis for achieving a pregnancy. OATZ, ATZ and ATZ with varicocele presented high percentages of ssDNA and dsDNA fragmentation (high-equivalent Comet assay profile), ATZ with varicocele being associated with the worst prognosis, due to higher levels of DNA fragmentation. Rearranged chromosome carriers display a very high variability and, interestingly, two different profiles were seen: a high-equivalent Comet assay profile, which could be compatible with a bad prognosis, and a non-equivalent Comet assay profile, which has also been found in three fertile donors.

CONCLUSIONS

Comet assay profiles, applied to different clinical groups, may be useful for determining prognosis in cases of male infertility.

Source:
http://humrep.oxfordjournals.org/rss/current.xml

Glycoconjugates recognized by peanut agglutinin lectin in the inner acellular layer of the lamina propria of seminiferous tubules in human testes showing impaired spermatogenesis

BACKGROUND

The aim of this study was to evaluate the histochemical characteristics of the thickened inner acellular layer (IL) of the lamina propria specifically present in the human seminiferous tubules of testes showing impaired spermatogenesis.

METHODS

Eighteen biopsies for the investigation of infertility and 10 orchiectomies for testicular cancer and cryptorchidism were used. Lectin staining [peanut agglutinin (PNA), Maackia amurensis (MAA), Sambuccus nigra (SNA)], PNA lectin staining with sialidase digestion, immunohistochemistry and binding assay of progesterone were performed and analysed quantitatively.

RESULTS

The IL of the thickened lamina propria of the seminiferous tubules in the testes showed PNA lectin affinity and binding affinity for progesterone. Both affinities of MAA and SNA were in the IL of only fairly thickened lamina propria. Furthermore, a positive correlation was present between the thickness of the lamina propria and the accumulation of glycoconjugates showing PNA lectin affinity (r = 0.829, P < 0.001) or progesterone (r = 0.629, P < 0.001) in the IL. However, ILs show no immunoreactivities of progesterone receptor, androgen receptor or human serum albumin. Progesterone inhibited the binding affinity of PNA lectin to the IL (P < 0.001), but not the affinity to the spermatogenic cells. In addition, sialidase digestion increased the PNA affinity not in the IL but in the spermatogenic cells (P < 0.001).

CONCLUSIONS

These results indicate that the IL of the thickened lamina propria always consists of glycoconjugates with PNA lectin affinity and possible binding affinity to progesterone. In addition, the glycoconjugates in the IL may be predictors of abnormal spermatogenesis in the testes of infertile patients.

Source:
http://humrep.oxfordjournals.org/rss/current.xml